A vascular access is an opening made in your skin and blood vessel during a short operation. When you have hemodialysis, your blood flows out of the access into the hemodialysis machine. After your blood is filtered in the machine, it flows back through the access into your body.

There are 3 main types of vascular accesses for hemodialysis. These are described as follows.

Fistula: An artery in your forearm or upper arm is sewn to a vein nearby.

• This allows needles to be inserted into the vein for dialysis treatment.
• A fistula takes from 4 to 6 weeks to heal and mature before it is ready to use.

Graft: An artery and a vein in your arm are joined by a U-shaped tube made of a special material called polytetrafluoroethylene (PTFE) under the skin.

• Needles are inserted into the graft when you have a dialysis.
• A graft can be ready to use in 2 to 4 weeks.

Central venous catheter: A soft plastic tube (catheter) is tunneled under your skin and placed in a vein in your neck, chest, or groin. From there, the tubing goes into a central vein that leads to your heart.

• A central venous catheter is ready to use right away.
• It is usually used only for a few weeks or months.

You may have a little redness or swelling around your access site for the first few days. If you have a fistula or graft:

• Prop your arm on pillows and keep your elbow straight to reduce swelling.
• You can use your arm after you get home from surgery. But, do not lift more than 10 pounds (lb) or 4.5 kilograms (kg), which is about the weight of a gallon of milk.

Taking care of the dressing (bandage):

• If you have a graft or fistula, keep the dressing dry for the first 2 days. You can bathe or shower as usual after the dressing is removed.
• If you have a central venous catheter, you must keep the dressing dry at all times. Cover it with plastic when you shower. Do not take baths, go swimming, or soak in a hot tub. Do not let anyone draw blood from your catheter.

Grafts and catheters are more likely than fistulas to become infected. Signs of infection are redness, swelling, soreness, pain, warmth, pus around the site, and fever.

Blood clots may form and block the flow of blood through the access site. Grafts and catheters are more likely than fistulas to clot.

The blood vessels in your graft or fistula can become narrow and slow down the flow of blood through the access. This is called stenosis.

Following these guidelines will help you avoid infection, blood clots, and other problems with your vascular access.

• Always wash your hands with soap and warm water before and after touching your access. Clean the area around the access with antibacterial soap or rubbing alcohol before your dialysis treatments.
• Check the flow in your access every day. The flow creates a mild vibration in the access, also called thrill. Your provider will show you how.
• Change where the needle goes into your fistula or graft for each dialysis treatment.
• Do not let anyone take your blood pressure, start an IV (intravenous line), or draw blood from your access arm.
• Do not let anyone draw blood from your tunneled central venous catheter.
• Do not sleep on your access arm.
• Do not carry more than 10 lb (4.5 kg) with your access arm.
• Do not wear a watch, jewelry, or tight clothes over your access site.
• Be careful not to bump or cut your access.
• Use your access only for dialysis.

Contact your provider right away if you notice any of these problems:

• Bleeding from your vascular access site
• Signs of infection, such as redness, swelling, soreness, pain, warmth, or pus around the site
• A fever 100.3°F (38.0°C) or higher
• The flow (thrill) in your graft or fistula slows down or you do not feel it at all
• The arm where your catheter is placed swells and the hand on that side feels cold
• Your hand gets cold, numb or weak

Arteriovenous fistula; A-V fistula; A-V graft; Tunneled catheter

Kern WV. Infections associated with intravascular lines and grafts. In: Cohen J, Powderly WG, Opal SM, eds. Infectious Diseases. 4th ed. Philadelphia, PA: Elsevier; 2017:chap 48.

National Institute of Diabetes and Digestive and Kidney Diseases website. Hemodialysis. www.niddk.nih.gov/health-information/kidney-disease/kidney-failure/hemodialysis. Updated January 2018. Accessed November 19, 2024.

Yeun JY, Young B, Depner TA, Chin AA. Hemodialysis. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 63.

Updated by: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.